Inappropriate Discharge to Homeless Shelter Without Adequate Support
Penalty
Summary
The facility failed to ensure that a resident was discharged to an appropriate setting that could meet his needs and preferences. The resident, a male with a history of stroke resulting in right-sided hemiplegia and hemiparesis, severe cognitive impairment, bowel and bladder incontinence, and a history of falls, was discharged to a men's homeless shelter. At the time of discharge, assessments indicated that he required substantial to maximal assistance with most activities of daily living (ADLs), including bathing, dressing, toileting, and personal hygiene, and had significant communication deficits due to aphasia and dysarthria. The resident also had a swallowing disorder and required a mechanically altered diet while in the facility. Despite these needs, the discharge plan involved sending the resident to a homeless shelter that only provided 30 days of emergency housing and did not offer assistance with ADLs or medication management. Interviews with shelter staff revealed that the resident was unable to read, write, or speak effectively, and required explanations and assistance to understand shelter rules. The shelter did not allow staff to assist with showering, and the resident struggled with basic hygiene and medication adherence. The resident was unable to consistently take his prescribed medications, as the shelter could not store or administer them, and he had memory issues that prevented him from managing his medication independently. Facility staff, including social workers and nursing staff, indicated that the discharge was prompted by the end of a payment agreement with the hospital and the lack of available family support or financial resources for continued care. Although some staff believed the resident could perform his own ADLs, multiple interviews and documentation indicated ongoing dependence for personal care and hygiene. The resident expressed fear and difficulty functioning at the shelter, and family members reported concerns about his safety and well-being post-discharge. The facility's actions resulted in the resident being placed in an environment unable to meet his documented care needs.